临床因素与肺囊炎肺炎相关尽管其主要预防:什么时候停止预防?
Ju Yeon Kim1, Se Rim Choi2, Jin Kyun Park3
1Division of Rheumatology, Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong-si, South Korea.
过早停止Pneumocystis jirovecii肺炎 (PJP) 预防,特别是高剂量葡萄糖皮质类药物,增加了类风湿性疾病患者的风险. 减速到12.5毫克的普得尼松等价物是一个更安全的戒断点.
科学领域:
- 类风湿病学 类风湿病学
- 传染性疾病 传染性疾病
- 药理学 药理学是指药理学的学科.
背景情况:
- 在接受免疫抑制剂的风湿病患者中,建议对Pneumocystis jirovecii肺炎 (PJP) 进行初级预防.
- 暂停PJP预防的最佳时间尚不清楚,这对患者构成风险.
研究的目的:
- 为了确定风险因素的PJP在风湿病患者尽管预防.
- 为最佳的PJP预防计划提供基于证据的建议.
主要方法:
- 一项病例控制研究,涉及1,148名风湿病患者中的1,294个预防性发作.
- 三甲-硫甲醇 (TMP-SMX) 用于预防.
- 考克斯的比例危险模型与LASSO被用来评估临床因素.
主要成果:
- 在10名患者中发生了PJP (0.85/100人年),主要是在停止TMP-SMX后.
- 在预防中断时,较高的葡萄糖皮质激素剂量 (>12.5毫克普雷迪尼松相当量) 显著增加了PJP风险 (aHR:13.84).
- 在15.9%的病例中,观察到TMP-SMX的不良事件.
结论:
- 当葡萄糖皮质激素剂量逐渐减少到每天12.5毫克的普雷尼松相当剂量时,启动PJP预防撤销是一个合理的策略.
- 这种方法可能有助于减轻患有风湿性疾病的患者PJP的风险.
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